Patient and technique survival among a Canadian multicenter nocturnal home hemodialysis cohort

Abstract

Background and objectives: As a result of improved clinical and quality-of-life outcomes compared with conventional hemodialysis, interest in nocturnal home hemodialysis (NHD) has steadily increased in the past decade; however, little is known about the flow of patients through NHD programs or about patient-specific predictors of mortality or technique failure associated with this modality. This study addressed this gap in knowledge.

Design, setting, participants, & measurements: This study included 247 NHD patients of the Canadian Slow Long nightly ExtEnded dialysis Programs (CAN-SLEEP) cohort from 1994 through 2006 inclusive. The association between program- and patient-specific variables and risk for adverse outcomes was determined using uni- and multivariable Cox regression.

Results: A total of 14.6% of the cohort experienced death or technique failure. Unadjusted 1- and 5-year adverse event-free survival was 95.2 and 80.1%, respectively. Significant predictors of a composite of mortality and technique failure included advanced age (P < 0.001), diabetes (P < 0.001), central venous catheter use (P = 0.01), and inability to perform NHD independently (P = 0.009) and were adjusted for center effect. Weekly frequency of NHD was not predictive. Age and diabetes remained significant with multivariable analysis (hazard ratio 1.07 and 2.64, respectively). Unadjusted 1- and 5-year technique survival was 97.9 and 95.2%, respectively. Only age was a significant predictor of technique failure.

Conclusions: NHD is associated with excellent adverse event-free survival. This study underscores the importance of modality-specific predictors in the success of home hemodialysis, as well as favorable baseline characteristics such as younger age and the absence of diabetes.

Figure 1.

Overall NHD cohort retention censored only at time of study termination.

Figure 2.

Patient disposition of the multicenter CAN-SLEEP NHD cohort from 1993 to year-end 2006.

Figure 3.

Event-free survival from adverse outcomes (composite of death and technique failure; n = 36 events) among the NHD cohort with analysis censored for transplantation and cohort dropout unrelated to technique failure.

Figure 4.

Survival from adverse events (composite of death and technique failure; n = 36 events) according to age strata 18 to 39 years (n = 85 individuals; 34%; solid line), 40 to 49 years (n = 69 individuals; 28%; dashed line), and >50 years (n = 93% individuals; 38%; dotted line).